The effect of Remote Ischemic Preconditioning (RIPC) on myocardial injury and inflammation in patients with severe aortic valve stenosis undergoing Transcatheter Aortic Valve Replacement, (TAVΙ).


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The effect of Remote Ischemic Preconditioning (RIPC) on myocardial injury and inflammation in patients with severe aortic valve stenosis undergoing Transcatheter Aortic Valve Replacement, (TAVΙ).

Hellenic J Cardiol. 2021 Feb 19;:

Authors: Halapas A, Kapelouzou A, Chrissoheris M, Pattakos G, Cokkinos DV, Spargias K

Abstract
BACKGROUND: Remote ischemic preconditioning (RIPC) is being evaluated as a strategy to reduce cardiac injury and inflammation in patients undergoing diverse cardiac invasive and; surgical procedures. However, it is unclear whether RIPC has protective effects in patients; undergoing the transfemoral transcatheter aortic valve implantation (TF-TAVΙ) procedure.
METHODS: Between September 2013 and September 2015, 55 consecutive patients were prospectively randomly assigned to receive SHAM preconditioning (SHAM, 22 patients) or Remote Ischemic Preconditioning (RIPC) (4 cycles of 5 min intermittent leg ischemia and 5 min reperfusion, 33 patients) prior TF-TAVI. The primary endpoint was to determine the serum levels of: hs-cTn-I (necrosis), CK-18 (apoptosis) and IL-1b (inflammation). Quantification was performed using commercially available ELISA kits. Patients were sampled 1-day pre TF-TAVΙ and 24-hours post TF-TAVΙ. Secondary endpoints included: total mortality, incidence of periprocedural clinical acute myocardial infarction (AMI), acute kidney injury (AKI) and stroke.
RESULTS: 22 SHAM patients and 33 RIPC patients were finally analyzed. Our data revealed no significant differences in serum levels of hs-cTn-I and CK-18 among groups. However, in the RIPC group the IL1b level increase was significantly lower 24h post TF-TAVΙ, (p<0.01). There were no significant differences between groups in the secondary endpoints at the follow-up interval of 1 month. No RIPC-related adverse events were observed.
CONCLUSIONS: Our data suggest that RIPC did not exhibit significant cardiac or kidney protective effects regarding necrosis and apoptosis in patients undergoing TF-TAVΙ. However, an important anti-inflammatory effect was detected in RIPC group.

PMID: 33617961 [PubMed – as supplied by publisher]

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